Basic Information
| Provider Information | |||||||||
| NPI: | 1194832048 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GLOBAL NUCLEAR MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 MCKINLEY AVE | ||||||||
| Address2: | |||||||||
| City: | KELLOGG | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838372693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087832465 | ||||||||
| FaxNumber: | 2087864471 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 MCKINLEY AVE | ||||||||
| Address2: | |||||||||
| City: | KELLOGG | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838372693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087832465 | ||||||||
| FaxNumber: | 2087864471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HESTON | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2087832465 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | M6643 | ID | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.